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Aetna Medicare Value Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value Plus (HMO) in 2025, please refer to our full plan details page.
Aetna Medicare Value Plus (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Wichita Kansas Area. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Aetna Medicare Value Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Value Plus (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Value Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.60. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Value Plus (HMO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy used. For preferred generic drugs, you'll have no copay at preferred pharmacies and a $12 copay at standard pharmacies. Standard generic drugs have a 24% coinsurance, while preferred and non-preferred brand drugs have 25% coinsurance. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan offers comprehensive coverage with varying costs for different services. Inpatient hospital stays have a $250 copay for the first few days, while outpatient services have copays ranging from $0 to $250. Emergency and urgent care services have copays, and primary care visits have no copay. This plan also includes coverage for preventive, hearing, vision, and dental services, with specific copays or no copays depending on the service. Additionally, it covers home health, medical equipment, and diagnostic services with copays or coinsurance, as well as skilled nursing facility stays with a copay. Other benefits include acupuncture, over-the-counter items, and prescription hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $250 copay for days 1-4, and no copay for days 5-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $250, and observation services with a $250 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a $20 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Aetna Medicare Value Plus (HMO) plan, but requires prior authorization. You will have a copay of $85 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Aetna Medicare Value Plus (HMO) plan. Ground ambulance services have a $260 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Value Plus (HMO) plan. Emergency Services have a $120 copay and no coinsurance, while Urgently Needed Services have a $20 copay and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $120 copay, and Worldwide Emergency Transportation has a $260 copay; all have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services have a $20 copay, but routine care is not covered. Occupational Therapy Services have a $15 copay. Physician Specialist Services have a copay between $0 and $20. Mental Health Specialty Services have a $20 copay for individual and group sessions. Podiatry Services and Other Health Care Professional services have a $20 copay. Psychiatric Services have a $20 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $15 copay. Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $20. Opioid Treatment Program Services have a $20 copay.
Preventive Services See details
Preventive services include coverage for annual physical exams with no copay, as well as additional preventive services, kidney disease education services, and other preventive services. Additional preventive services have a copay, while kidney disease education services have a 20% coinsurance, and other preventive services have a copay for specific services.
Hearing Services See details
The Aetna Medicare Value Plus (HMO) plan covers hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum benefit of $1500 per year, while inner ear, outer ear, and over the ear hearing aids are not covered, along with OTC hearing aids.
Vision Services See details
Vision Services are covered, including eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $275.00 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other dental services with a $2,500 maximum per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Aetna Medicare Value Plus (HMO) plan, but require prior authorization. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered by Aetna Medicare Value Plus (HMO). Durable Medical Equipment has a coinsurance of 0-20%, and Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Medical Supplies and Diabetic Supplies have a coinsurance of 0-20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Aetna Medicare Value Plus (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $140, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Aetna Medicare Value Plus (HMO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Aetna Medicare Value Plus (HMO) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, the plan does not cover these services in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Value Plus (HMO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Aetna Medicare Value Plus (HMO) covers acupuncture with a $20 copay, and also covers over-the-counter items with no copay, up to a $75 benefit every three months. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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